FIRST EXPERIENCE WITH LAPAROSCOPIC SPINE FUSION IN AN EXPERIMENTAL-MODEL IN THE PIG

Background: We elucidated whether anterior lumbar spine fusion with in terbody implants (BAK) can be performed in an experimental model in th e pig using a transperitoneal laporoscopic approach. Methods: In seven animals, a pneumoperitoneum with an intraabdominal pressure of 12 mmH g was induced, and five trocars were placed in the middle, as well as in the left and right lateral aspect of the abdomen. With the use of s pecially designed instruments, the bifurcations of the aorta and vena cava were prepared. The sacral artery, overlying the anterior aspect o f the L5/S1 disc space, was retracted, allowing the exposure of the di sc space. A working trocar was then fixed to the spine bodies above (L 6) and below (S1) the disc, and instrumentation was completed by destr uction of the disc, insertion of distraction plug, and implantation of the BAK cage. X-ray control allowed exact positioning of the cage. Re sults: There were no major complications during the operative procedur e, in particular no bleeding from major blood vessels and no injury to intraperitoneal organs. Cages were implanted in all animals in correc t position, as indicated by postoperative X-ray control. Conclusions: We conclude from our experiments that in the pig model implants for an terior interbody lumbar spine fusion can be inserted successfully usin g the laparoscopic approach. We propose that the pig model represents an ideal tool for training before applying this operative procedure in men.